Palm Side Wrist Pain From Gaming

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Palm-Side Wrist Pain From Gaming

Creative Warrior Tendinopathy | Flexor Digitorum superficialis/Flexor Digitorum Profundus Tendinopathy

Expert Opinion

One of the most commonly reported pain patterns in gaming is palm-side wrist pain from gaming we will be discussing how to fix it
One of the most commonly injured areas in gaming due to the stress and strain put on the finger flexors
Creative Warrior Tendinopathy is irritation of two tendons that cross the wrist and leads to the tips of the fingers
These muscles/tendons are responsible for gripping and clicking the mouse or hitting various keys on a keyboard

Creative warrior tendinopathy is a condition that affects two muscles/tendons in your forearm, wrist, and fingers. Tendons are like little ropes that connect your muscles to your bones, and they help you move specific joints. When you play video games or use your wrist and fingers a lot, these tendons can get irritated and swollen, causing pain. These tendons in particular are what allows each person to bend their fingers and click/push buttons and can be seen in the highlighted color to the right.

This diagnosis is termed “Creative Warrior Tendinopathy” due to the frequent occurrence in Fortnite gamers. In Fortine, gamers are often switching between weapons or making/editing builds in a very rapid manner. This leads to extremely high APMs (Actions Per Minute) which can lead to overuse of the finger flexor muscles/tendons. Through improper positioning, poor conditioning, or inadequate rest these tendons will take the brunt of this and elicit pain. This name “Creative warrior tendinopathy is also interchangeable with Flexor digitorum superficialis/flexor digitorum profundus (FDS/FDP) tendinopathy, the two muscles involved in this injury. This diagnosis is vastly different from carpal tunnel syndrome as carpal tunnel from gaming is much less common than many know and believe. Discussed below are just a few simple, but effective ways to fix wrist pain from gaming.

Common Things You Might Feel?

Gamers are likely to begin experiencing pain and discomfort while playing and a sore, achey, or stiff feeling after in the area indicated above. Weakness is also likely to be present with gripping and moving the mouse. This is likely to decrease performance and alter the gameplay of the individual where movements may be slowed or less precise. Pain will be worse with any gripping or pinching required throughout the day such as shaking up a protein shake, pulling a laptop/books out of a backpack, or gripping a dumbbell.

Disclaimer

The following information is provided for general educational purposes only and should not be considered medical advice. It is not intended to replace consultation with a qualified healthcare professional. If you have specific concerns or questions about your health or medical condition, please seek the guidance of a licensed physician or another qualified medical practitioner. Any reliance you place on the information provided is solely at your own risk. In no event will the author or 1HP be liable for any loss or damage arising from using this information. Always consult with a healthcare professional before starting or changing any medical treatment or regimen.

How Does It Happen to Gamers?

Gamers use their fingers a lot! Gamers are at risk because of the long durations we play. Oftentimes this means we are taking less rest breaks when we are in the zone because we don’t always think to put our body first. Pain is something that can be reduced from distractions and gaming is a good distractor which makes it hard for gamers to know when to stop due to pain. Gamers are also at risk because of the specific motions required when playing. Computer gamers in particular are at an increased risk compared to mobile and console gamers due to the nature of the games and the speed/force they need to push/click buttons. Each time the mouse is clicked, these muscles/tendons are being used. It is less about the amount that they are clicked, but more about the force gamers are putting into each button click. The greater the speed and force, the greater the muscle stress and activation (Yoo, 2015).

For a short video explanation about how overuse injuries can develop in gamers and how to help them, check out the video linked here:

How to fix it / Recover / What can you do? Strategies to manage symptoms?

Returning from this injury takes a concerted effort, but can be done without much time away from the game. Below are a few steps that individuals need to understand and take when pain in this area occurs.

Identify the issue (One of the most important factors is early detection…do NOT push into or through pain)
Rest the wrist/fingers (Few days of reducing the workload, but be sure to continue moving the wrist, fingers, elbow)
- Splinting: This may be one way for individuals to rest the irritated tendon. It is important for a gamer to know that this should be used as minimally as possible, but may be necessary for very painful acute symptom management.
- Splints for this diagnosis are rarely recommended as it is relatively restrictive, but if necessary then look for a “resting hand splint”.
Massage in times of pain/discomfort
Utilize heat/ice (Hot/cold packs, warm water soak)
- Heat can be helpful before or during activity. Ice can be helpful following activity in the presence of pain. Be cautious using ice over specific nerves as this may lead to irritation.
Initiate isometric exercises **
- A good starting exercise to regain/maintain strength while limiting further pain or irritation
Stretching **
- Helpful in reducing pain throughout the entire range of motion
Isotonic strengthening **
- Necessary to improve strength and endurance to decrease pain while playing and prevent future injury from returning

Additional tip: Consider utilizing lifting hooks to help decrease the muscle recruitment necessary for pulling or certain gripping movements while lifting such as deadlifts, rows, bicep curls, lat pulldowns, etc. This should only be used when pain is present and not as something to rely on for all training. (Not an endorsement of IronBull Strength)

*Surgery is very rarely required in order to effectively treat

Lifting Hooks

For a comprehensive guide on the exercises discussed, check out the videos on our Fix Wrist Pain link here

Science Behind The Injury

The diagnosis was explained in short above, but for those wanting to know and learn more this is for you.

Specifically, this diagnosis is looking at two tendons (connect muscle to bone) which are responsible for bending (flexing) the fingers. These tendons can feel irritated at various points such as the wrist crease as they run from near the elbow into the tips of the fingers. Through repetitive use, inadequate amounts of rest, or forceful clicking the tendon can experience inflammation which if ignored may lead to structural damage over time. This overuse leads to a pain response to warn the body of damage so that individuals will stop the aggravating activity.

Tendons responsible:

Flexor Digitorum Superficialis

- The muscle is responsible for being the primary flexor of the proximal interphalangeal (PIP) joints of the middle phalanges of all the fingers aside from the thumb (digits 2-5)while also assisting in flexion of the metacarpophalangeal (MCP) in the same fingers.

The muscle originates at the medial epicondyle and shaft of the radius where it attaches to the volar aspect of the middle phalanx of digits 2-5.

Flexor Digitorum Profundus

- - The muscle is responsible for being the only flexor of the distal interphalangeal (DIP) joints of the distal phalanges of all the fingers aside from the thumb (digits 2-5) while also assisting in flexion of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the same fingers.
  - The muscle originates at the shaft of the ulna and interosseous membrane where it attaches to the volar aspect of the distal phalanx of digits 2-5.

Both muscles also help with bending the wrist towards the palm (wrist flexion)

It should also be known that gaming is not the only activity to bring on this condition and certainly other lifestyle factors play a role. School, work, and other hobbies can also further stress this tendon and can be important to thoroughly evaluate as well. This injury specifically can also be common in climbers.

Differential Diagnosis:

Ganglion Cyst-A fluid filled sac that grows from the lining of our joints, often times needs to be removed. This is important to seek medical advice from a doctor regarding treatment.

Wrist Instability- The wrist is comprised of several different supporting structures such as ligaments (Hold bone to bone) and tendons (Hold muscle to bone). Certain individuals may have anatomical variations in the length or alignment of their bones or even experience an injury throughout their life. This can lead to increased strain and demand on the supporting structures which may result in pain and overall decreased performance.

Preventative Approach

There are several approaches to take in order to prevent this injury from occurring or coming back. There are 3 main factors to first focus on and address, but it is also important to keep in mind other secondary factors which can be helpful to address.

Strengthening exercises (Important for building up a foundational base to allow the tendon/muscle to keep up with the workload they are being asked of)
Intermittent stretching (During and after gaming sessions)
Proper warm-up (Promotes blood flow to the muscles/tendons and lubricates stiff joints)

Additional

Ergonomics/positioning
- (Poor positioning could put the muscles/tendons in a compromised position which forces it to work harder therefore making it more susceptible to injury)
Rest breaks
- (Pain levels can be reduced through distractions. Gaming is a big distractor, meaning that individuals should take breaks every 45-60 minutes to assess how you are feeling. Additionally, the break may not need to be the same for each person. If the injury severity is high then it may be better to take more frequent or longer breaks vs someone who has mild stiffness or discomfort where breaks can be more infrequent or shorter in duration)
- Creating a schedule that works for you and your game is also recommended. For example, consider taking a 10 minute break after 2 ranked games (~60 minutes) or a short 5 minute break to stretch following 1 ranked game (~30 min). Certain games will vary in duration, but planning ahead and forming a routine will be beneficial in the long run to avoid overuse. A general rule of thumb is, the longer you play, the longer the break should be to allow for some recovery. )
Massage
- (Helpful at times whenever pain or tenderness is present)
Ice
- (Following long bouts of gaming if painful)
Heat
- (Prior to gaming sessions or stretches)
Relative rest
- (If tenderness becomes apparent over the palm side wrist area shown above then it is best to reduce the time playing or take some added time off)
Sleep/Nutrition/Mental health
- (These underlie all of what is experienced in a day and cannot be ignored in injury prevention)

References

Yoo W. G. (2015). Effects of different computer typing speeds on acceleration and peak contact pressure of the fingertips during computer typing. Journal of physical therapy science, 27(1), 57–58. https://doi.org/10.1589/jpts.27.57